Management of women referred to an acute gynaecology unit: impact of an ultrasound based model of care for women with acute gynaecological complications.

OBJECTIVE:: To assess the impact of the introduction of an ultrasound-based model of care for women with acute gynaecological complications. METHODS:: Prospective comparative study. Analysis of women attending the Acute Gynaecology Unit (AGU) during six week period four months after unit's inception (model of care), and during similar period six months immediately before (traditional model). In the ultrasound-based model of care, ultrasound was made available at initial clinical interface. The main outcome measures were admission rates and occupied bed stays. RESULTS:: 290 consecutive women with complete data were included. 133 before and 157 after the introduction of AGU. The AGU resulted in significant decrease in admission rate (36% to 7%, p<0.0001), time to see trainee gynaecologist (205 to 172 min, p=0.00089), time to ultrasound (533 to 199 min, p<0.0001), length of stay as an outpatient (248 to 45 min, p<0.0001) and occupied bed stays (85 to 30 days, p<0.0001). This model resulted in significant decrease in surgical intervention rates (29% to 12%, p=0.00025) and increase in expectant management (8 to 26%, p=0.00023). The reduction in occupied bed stays over one year represented a total saving of $257,617 AUD. CONCLUSIONS:: In the AGU, the availability of ultrasound carried out by a senior clinician with an interest in gynaecological emergencies may lead to a reduction in admissions and improved outcomes. Copyright (c) 2009 ISUOG. Published by John Wiley & Sons, Ltd.